240808 (SFD)BUILDING PERMIT
CONSTRUCTION ESTIMATE
1 ST FL. SQ.FT. @ 13L 15"
2ND FL. SQ. FT. @
POR. 133 SQ. FT. @ 1-503
GAR. SQ. FT. @ 4-2 2,
CAR P. SQ.FT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $ �.
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
%/FhIT QVCTCAA NrA AI m FvAP rnnl X1 HOOD
EPARTMENT OF BUILDING & SAFE'
COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
!s-20 I UNITS
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL, COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
BOILER I I B.T.U.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO ISH)
11 1
APPLIANCE ft7w GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER i KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC 2 WATER CLOSET
COMPRESSOR HP 4.POLE, TEMP/PERM 2 LAVATORY S- Div—
HEATING SYSTEM I$ FORCED ❑GRAVITY 400 AMPERES SERV ENT SHOWER
SOFT @ a 2 BATH TUB 3 CO
SQ FT @ a 1 WATER HEATER
SOFT RESID @ 1 a i SEWAGE DISPOSAL
SQ FT GARAGE @ '/aa 2 16 HOUSE SEWER
PERMIT FEE j 3 (* i I TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE Is
I I PERMIT FEE 14 00 ] PERMIT FEE Q(a
IT8,0
TOTAL FEES
MOB. HM. FEE MICRO
FEE
MECH. FEE
DBL.
PL. CK. FEE
CONST. FEE
DBL. ELECT.
FEE
DBL.
SMI FEE
FEE PLUMB. FEE
DBL
2411
81
171.22
19.00 I
I X.00
69-00
I 1&%
I 1.26
I
3D.00
J I F I M I A M I J I J I A I S 1 O N I D
JOB ADDRESS �" �- � � SP NO
52— `600 &Vo_."So
OWNER
fte i f Tc.s liege tam
73
74
USE OF PERMITr,
jw . & .
F.C.
001
DATE �
1-10--74 1
PER T N .
75
M H PERMIT FEE
$
COMMUNITY DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT OFFICE
111
I 17.97 Q$
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
!
MECHANICAL FEE
DBL
$
SETBACK L T512E ZONE
USE NO.
GRP
CK BY
TYPEIt
tin
F20 S R
I I
PLAN CHECK FEE
$
BOND AMT.
PLAN NO. PLAN CHECKER
FINAL DATE INS
PE OR
I
J
I
CONSTRUCTION FEE
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLVED
00
nedt of Callfwala
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
califii
SMI FEE
$
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 12XD4&YS. CESSA•
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
1 HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC.
$
FEE
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
DBL
PLUMBING FEE $
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.
$
OWNER/AGENT'S SIGNATURECONTRACTOR
4' 'o--
TOTAL FEES
17,277
--
CASH 0 CHECK M.O. ❑ N.C. ❑
ADDRESS
ADDRESS
RECEIVED BY r TREES REQUIRED
��!
=
CIT 21P CODE
CITY 21P CODE
SEWAGE SYSTEM
T LL P
INFORMATION
1
TEL. NO.
TEL. NO. LICENSE
FORM 284-2081Rev. 9.73, OPs
I . . n-11 — -1-1 INPqA"CWAal%'
'L)'� 'G_
PERMIT
BU iiiIING-PERMIT DEPARTMENT OF BUILDING & SAFE FIELD
.7y
COUNTY OF RIVERSIDE bs
CONSTRUCTION ESTIMATE
N0. ELECTRICAL FEES NO. PLUMBING FEES
. j."t
ISTFL.� 1176
1 5 T FL.'
SO.Fl. a LIM 15.785.20 UNITS
--.2r4D
2r.4D.'FL.
SO. FI. a-
BOILER B.T.U.
(IOR.' 133
..FOR
50. FT. @ 2.1 332,
% MOBILEHOME SVC BAR SINK
437
so. Ff. 0 4.2 1.&W,25 POWER CUTLET ROOF DRAINS
CAR P.'
SQ.Fl. 0—
DRAINAGE PIPING
WALL
so. Fr. @
DRINKING FOUNTAIN
SO. FT. 0
URINAL
ESTIMATED CONSTRUCTION VALUATION is WATER PIPING 1 4 150,
NOTE: Not to be used as properly tax volucii tan
SWIM POOL, PVT FLOOR DRAIN
MECHANICAL FEES
Swim POOL. COMM WATER SOFTENER
VENT SYSTEM IXFAN 0 EVAP. COOL X) HOOD
SIGN I WASHER iAUTOfplSHI SM
APPLIANCE DC7=
3 00 1 GARBAGE DISPOSAL
FURNACE OUNII OWALL OFLOOR OSUSPIENDED
LAUNDRY TRAY
AIR HANDLING UNIT I CFA%
IDLE METER I KITCHEN SINK I
ABSORPTION SYSTEM
TEMP USE PERM SVC 2 WATER CLOSET 3 1w.
COMPRESSOR �� vip
4 00 POLE-TEMP/PERM 2 LAVATORY 3 Q0 -
HEMINGSYSTEM QkFORCED OGRAVITY
4 C* AMPERES SERV ENT 1 00 SHOWER
SQ Fr 0 c 2 BATH TUB
SOFT 0 4 1 WAIERHfAIE;t
•
SOFTRESID @ 14: 111 78 1 SEWAGE DISPOSAL Ila 00,
SO FT GARAGE 0 '/,c in HOUSESEWER'_
PERMIT FEE
3 TEMP ELEC SVC GAS PIPING
-9080 HOME PERMIT FEE 5
PERmJT FEE 4 001 11 PERMIT FEE 2 M,
TOT&FEES
05. "M. ft
"ROFEE
UZZ70-ii
AL CK FEE CONST. FEE
ELECT.
FEE
SMI FEE
FEEI PLU;
th.2. r
1.9
1081]
00 fi
.g. m18.45
IDOL.I
I . 26
I
JOS ADDRESSS�.O
OWNER
52-780 AM. Rim I
PaltifICA
7T 77%�.- i
USEOf PERwrr
F C.
ATE
& =age 1
001 ID
1-10-7
b808�
"M H,'PERMIT FEE
$
COMMUUTTY OST
UNITS
ROOMS
VALUATION
ISUPP. TO PERMIT
OFFICE
MIMF.ILM.FEE
COPIES
S
LEGAL DESCRIPTION
'2!1 0% 4% v I%
-HANICAL FEE
MEC
DBL
lot -ll rim -141-n
SET ZONE
17
USE NO.
—
GRP
—
TYPE CK BY'
F is JR16
S-7
I
PLAN CHECK FEE
S
00
Bono "t PLAN NO PLAN CHECKER FINAL DATE INSPECTOR
1
-41A
AA
J
CQ'tSTRUCTION FEE
DBL
S
NAME OF CONST LENDER BRANCH
OFFICE
No LEN D
-rJECTRICAL FEE
DBL
$
Ab"Ess CITY
STATE
SMI F.kE
b
THIS PERMIT SHALL BECOME VOID IF WORK Is NOT COMMENCED WITHIN I 70'MS. CESSA-
TION Of WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT To BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH TH15 PERMIT WILL BE DON INAC--'
FEE
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, ALSO
AGREE TO CARRY THIHE.'.�%
COMPENSATIONCOMPLIANCE• '
INSURANCE UPON MY EMPLOYEES. CO
LUMBttVG FEE.
DOL
SLAWS
OF THE STATE OF CALIFORNIA COVERING CONTRACTORS 15 ALSO GVA*NYEED�.,
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS ANDSKCIfi TIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE
C
OF IKE STATE 2f SAJIFORNIA
*wNERtA4ENrs spamAruntRA
Cola Cl-
'TREES REQUIP
A
'0
;nz-
Cl
'0"
I . . n-11 — -1-1 INPqA"CWAal%'
' •:dUILDTNti.P�lMJT DEPARTMENT OF BUILDING BcSAFETY HEADQUARTERS`• '�•�'�� `"''••- '':.'t
: J COUNTY OF RIVERSIDE , oT
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES:.',•..'L1:':
SO.FT. ® UNITS
t-'-�
kEND Fl ' ° SO. FT. ® BOILER L� B.T.U.
yl' r"(1 •,
rPOftti,: SO, FT. ® MOBILEHOMESVC, BARSINK
:C+l1R: j SQ.Fi, POWER OUTLET ROOF DRAINS
:CLLR P.' SOFT. a:T
®
DRAINAGE PIPING,
r DRINKING FOUNTAIN
$0. Fi. ® T
�Pd JURINAL;'r
; . i -•.. SO. FT. ®
< ES TIMATEOCONSTRUCTIONVALUATION S 17 975.00 1'WATERPIPING I:
}:y^�NOTE: Not.to LTe'lised as property talc valuation ' SWIM POOL, PVT BOOR DRAIN
MECHANICAL FEES SWIM POOL, COMM wATERSOFTENER
YENT SYSTEM ®FAN '• ❑ EVAP. COOL }D HOOD 5' 0' SIGN 1 WASHERMUTO ISH). 3' O
!� APPLIANCE Dryer 3 0 L GARBAGE DISPOSAL
?s�;i,•
FURNACE, ❑UNIT ❑ WALL ❑ FLOOR ❑ 5USPENDEO :LAUNDRY TRAY
AIR t1ANDlING UNR r CFM IDLE METER L KITCHEN SINK - 0 1
ABSORPI[ONSYSrEM' TEMP USE PERM SVC 2 WATEROOSET 3 O
�e,.i �:. •
COMPRESSOR ] HP 4 0 POLE TEMP/PERM 2 LAVATORY 3
HEATING SYSTEM• ®FORCED
ef: ❑ GRAVITY 4 Q AMPERES SERV ENT 1 00 SHOWER
SOFT 0 a 2 BATH TUB
SOFT 0 a 1 WATER HEATER
f i SO FT RESID 0 It 11 78 1 SEWAGE DISPOSAL •- tt
t:;T '• SO FT GARAGE 0%, Z •.L8 HOUSE SEWER
'+ PERMITFEE•.-;' ';; 3 Q TEMP ELECSVC GAS PIPING
'-.T1,,M061LE HOME PERMIT FEE': s' PER 11 FEE !{ OO 1 PETtMtT FEE
t •P R `: -TOTAL FEES •• M09. HLL fj5 MICRO FEE MECH. FEE OBL PL CK. FEE CONST, FEE OBL_ ELECT. FEE IDGIL15MIFEE. FEE PLUM!..FEE-:. jDeL.P.
19.00 34.00 68.00 8.96 1.26 30 Od'
Y ' '
+� (! � 1 J A S N JOB ADDRESS i SP No OWNER
7a 52-780 Ave,Diaz t 'c
_7a, USE OF PERMIT ,.i FC. DATE P 17 0 is;•
`^ '-?s'`''I I IDW1 & att. arae 00 1-10-74:
n ' M Fi: PERMIT FEE. 3 COMMUNITY DST UNITS R00M5 VALUAI ION SUPP. TO PERMF1111 .I"•'
r j•.':.
La uinta 11 1 0
r• MICROFILM FEE COPIES E LEcrtDfiscaIPnoN i'•
Lot 2 janta CarEoplita 1k 17 Ton 77 1- I
nm
MECTiANICAL FEE DBL S SET BACK LOT SIZE ZONE USE NO. GRP TYPE -
CR BY
19 .00 `20 5 5-7 i6 -
PLAN CHECK FEE 5 BOND AMT. PLAN NO PUN CHECKER FINAL DATE INSPECTOR
34 00
t' •,CONSTRUCTION FEE DBL. ° S:�M68 p r•L
� �• � _• •• L/Q HANE of CONST. LENDER BRANCH OFFICE NO LENDER INVOLVED
- • CCB Bank of California
ELECTRICAL FEE ' ' DBL ' $ ADDRESS
�i,•',•�� CITY STATE
1$ 96 Encino Calif.
SMI FEE,; $ THIS PERMIT SHALL BECOME VOID IF WORK IS NOT'COMMENCED WITHIN W16DAYS. CESSA• I '
•r
,•�S„ 1 26 TION OF WORK FOR 12D DAYS SHALL A150 CAUSE PERMIT TO BECOME VOID, 60
t
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BEGONE IN AC.
' . 3 CORDANCE WITH THE LAWS OF RIVERSIDE, COUNTY AND THE STATE OF CALIFORNIA, I ALSO
AGREE TO CARRY COMPENSATION INSURANCE UPON MY- EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS 15 ALSO GUARANTEED,
PLUMBING FEE' OBL S• I HEREBY CERTIFY THAT THE. INDIVIDUAL WHO PREPARED.THE PLANS AND -SPECIFICATIONS. '
��,,�`'`, 30 OO . HAS DONE SO IN,ACCORDANCE WITH SECTION 5541 OFTHE BUSINESS AND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA:
YIA
�' r • •�: - �l `-�T�•,� .. OWNER/AGENT'S SIGNATURE CONTRACTOR"•.FES•
=Pac'ifica:Wesrerri:' _ `•�
-.ir.CAs!4�•O..a'�/t:.<,• .CHECK ®; _ (hl'o.�.17 °t`1 Cr'D,�.:� � ,,V, ..... , � ', `` �
�eac)�?'���P•1:. i • .t.:, : _ ��!, S� _ -'`•.i,Titi•�-:.. • ,.,: _ ADDRESS,' �:. .. - ice. -.t
F�FLYjD:BYy'TREESRFOUy
r .11, "'•°: ':?� "1.`�i:: ;ate i • wY - • t �17Y'✓( •.T 41 COO • CITY' -r•c:: ' �.US`;,: ',:'.�1M c'p DEP:. •J %�
,)r,�ry:•u:,. uw�1. �;`(:". '.�%'f..�•''!`
' .r.�r' I•. t. '^ui::r.. .r.: •i.,:r,,.C: :!
'A •9' .•1% '" ,,,ter,. ':�F v)' `•`�r`%• ) ..t, ;4� n,`i;•.J,.i= •:✓.•: s. i' �i
t '.i,: :<•. J. : )' < �';:'.�.:' :'• ':. er _�' <.:� •tt...'!�'111):.' vJ 7�.4iJ't•': •.:• <,Y,
irs 'F?0. �8ifi•, cT,.r 1l';t ... 'P= : '1:% '.'f.tL�
a` L).: ,ti :�_: -'i T,'`4�_�atf ••1:` 1, 4.. -,1`i <'
� r:": .' : <._ i�?•, :.T• 1, � , .`,' "5�i lT. 1'f S 1 '4
t tR �;' :IN' ,q.�,a P•�+n �.`7(�'•r6 .,tti,. llTidTr.7iaiLl�o:•t ll r:.. Pr; .l `1 ..•E.7A: Jrf'•: •il:�l :L�. i•py, \:, '.h%;� :���.. rr.•%�♦ :Y%.q 1�•r.'i`I'ar•'"inPl.r� ,}, I
^S . ��l F.ORhMT1ON - � ; ' ` i, "f' ; : - �.1A'„ •{ '�; _ A ; :,. �._,..: t r,,. „ T .
�1' '4, p't,T. >h'�:.21N•. '� 'IIDi��`i 11 :''•-�',•:!nl:.: .:� ..r':'f: t:� s:r T[C31 ��,.. �•.v.•,Y `'Y.• _\A.+•UCF,NSBj^.` •'T,
•{; :., i :. ,.%_;. :�('� :•;i�._j j` a ..,t,. i�;=:is`�I, "�<, ,�:,•,- <.•• 'p.�i�SJ�r, y
. _ -`4: tJ��lrt:.l.i:�.,✓r`::.-. .. � �=r%,.^t`r ./.. :�e':�;1'�rd '+.1`.f�:': i�",a;•n'.' t-4�e",.f. _.,i:; L!)r:�:! • .. :'lf....,.._:-.. .r..:_.-r•..t':i.'`�: ,.S T•�``t'�t,t •+^<..TfA•L' ..
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! .. )Z!WiC3i'c1'•L�uJ. +�.:.1• ..n ll�•• MIRI1.
} ,•�i'1.1T�"+J�Lj"R1.y�f �1 n R t,'t�.i�:1'l•'�cn'�'e4� � yt+?RY.;j�'1*1�,"1.1'•i. •f"ti•�r•►'r...�..� ,_ y.�•%i,\ jai,..
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i
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': <<! • ,�,t•R•-I` `r+1►,j1 �`t �•• i^t, aL •�.' yrN i' �r a?1 a,a(��al I,�I♦� 'r.r•t' �i�� � 1 ,+� �, • ♦ • I r•J I �ti a,
�` •:' j'Y '•f r►++ ,7 r`' .�� ��'~ LI `�� I` % �'�+fir' r �' ��t r •^ ` +tib l r� -
S�•',. iy ,5•.y R�,J. . � . .rid , .�.` I: , , ` �
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1
6
y
Rar•!•• +�N
:''RIVERSIDE
."COUNTY:; DXP.ARTMENT-:OF' BUU.DiNG AND SAFEiY
' -.'CORRECTION NOTICE :'.
To: Permit No. •
.Add: _;Q"T� �� ' Date: l
-GROUND PLUMBING -- U.P.C., 1910 EDITION
/ Approved plarks shall be'on job for inspection. (U. B.C. 302).
2.
Toilet facilities s on site.12-311T. ealth & Safety Code).
_
3.
Post job card. (U.B.C. 304).
4.
Replace' cracked fitting at (309).
S.
Support soil, pipe each joint ( ), continuous ( - ). (316).
6.
Closet bend to extend- minimum floor level. (805).
v.
7.
-Off set plumbing out pf bearing footing. (315).
a
8.
Fill soil pipe with water for testing.. (318).
9.
Stop leaks on line. (318).
10.
Improper,"unapproved fittings on line. (405 and 310)..
It.
Minimum. 114" per, foot grade required on line. (407)-
12.
Gas line not permitted under slab. (1213-b).'
13-
Pipe shall not be installed it a strained position. (503), (1205).
14.
All horizontal vents required to drain to fixture it serves. (505).
15.
Total vent area to be equal to building drain. (504).
16.
Cleanouts to grade. (406), ;
FOOTING AND FORM INSPECTION--U.B.C., 1910 EDITION
1.
Approved plans shall be on. job for inspection. (302).
2.
Provide legal lot stakes. (301 and 304),
3.
Foundation footing to be 12 inches - 18 inches into undisturbed soil and 12 inches -
15 inches wide. (2905).
'*f
4.
Regrade and compact fill, minimum thickness of concrete floor. 31A Inches. (2629).
rr .
5.
.Fireplace footing to be 12 inches larger each dimension than fireplace. (2975),
6.
Interior bearing footings to -be 12 inches into undisturbed soil; width, minimum 12
5
inches. (2905).
-
7.
Pier footings minimum 14 inches square, depth 8 inches. (Chapt. 29).
int
S.
.Forms shall conform to plan; tied and braced, (2607).
r
9.
Minimum foundation height 6 Inches above finish grade. (2905).'
'(2608).
rS;
10.
Re -bar shall be tied in place.
1.1.
Provide footing.for veneer. Brick ( ), Rock (' ). (3006).
r
12.
Water piping on branch to too small. (1009 U.P.G.)
-�'
13.
Gas piping not permitted under slab. (1213-b U.P.C.).
;y
14.
Mastic required on all metallic plpes where they come through sleb'or
footings. (315 U.P.C.).
15.
Form shall be in place for tub trap recess, It shall be poured monolithic. (803 U.P.C.).. '
16.
Post job card. (U.B.C. 304),
;.
17-
Job not ready for Inspection.
w
INSPECTOR .::-
'=
CORRECT 'rHE• A10VE CIRCLED ITEMS AND'C+i►LL FGR; R�114iPECT Ok. .
w
284-233
REY.6/70
:�I •, Permit Copy f ':
,Department of. Building. and Safety
COUNTY . OF RIVERSIDE `
TO:.P.�t'Cc Fi e�} W ESWL -/P , fV 'Dist. -
ADDRESS:
Dist.ADDRESS: d2 ,-7-fG A E. ? Date
CORRECTION NOTICE
Permit No.- 12 60 ga.
.�. � 284�205�•,
Permit Copy
Department'of Building and .Safety .
COUNTY. OF RIVERSIDE
i�
7.'.'.... i�l•' 4•�•I• .�'
,4 ? NOTICEk TNiS `IS NOT fA BUILDING; PERMITOffl
Dist cc
%% �Y•`'
APPLICATIOtI '•TO ,CQlVSTRUCT.'• '::i*' t••,• ::'.�" ;<
DEPARTMEXT OF BUIL0iNO ANO SAFETY Permit No :. t%' •'
`�,� � � •��• • � COUNYY :Ord �•ItIVERSIpE :,.• �:sa�• `Y,,
owner • _Bi ii4 4 c4, Ve ttextil Architect Coirtiactor
Addrrss :ibo ;%aWi'�' 81� Addresi Addrgsit
Cil y t!lnian-. city__:. City
Pitons PhoriP Phone
' :' �: •' ! ,'y w ., I (wei Iho undersigned, hereby certify and acknowledge 11no1.1 {wet have caad' the application and agree that il• Curb and Gutter, and'
+' Paving,'w4lor Dedication of right of way Is requlroif•by,tKo:Couitty of Riverside, the-Riversklo'Couhty Department of'lluildino and,Satety,
shall not make a Flnitl I '
�
`' i .�:,:•„ ." �, rnspection until sold regirtiamerrts'hravo„bean ,teat. I-am also aware tlut no work to Bono within the Couhty, R/W.•
O., Without an emra chment permit.
:''• • a.',`,' _ NOW, therefore, It is agreed that 1 (we)i-
'Wii not
I, o,4nrPy•"id properly and'wlll not'csuso sifd prOpertytO.bo oeeupled until I (we),twve
'` b •• • complied with all laws of the County of Riverslde and the' State.of California governing said property.'
DATE 12_20-73 SIGNATURE OF OWN,
.ER.
11 f Approval by.Sipnaiure Irani tEie Following DepartmntseListed.,Below r
;•_�:.,': Must Be Obtained Piier.to.the I- ng.of,a,Can-shmetion.Pwmit., ,
-` USE OF. STRUCTURE
LOCATION' OFJOB kY.wax
SINGLE FAMILY ❑ -DUPLEX ❑''
LEGAL DESCRIPTION OF PROPERTY LDi 7
APARTMENTS [] AGRIC
ltlock 17O
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o'w amara” .a�lita1Z.•� PC�773-
,• .-fi =; Q., COMMERCIAL , [] INDUSTRIAL
.COMMUNITY ALTERATIONS El*
;•
Z NO, OF SUBMITTED PLANS TYPE OF CONSTRUCTION —."t R
r1, N'Q CASE NO.
;:tee..=."
=. 17.:.: •.
z'' OF PARKING SPACES REQUIRED NO. OF BUILDINGS NOW EXISTING
:ZONE 1-3 SETBACKS FRONT_ %a SIDE __ Z REAR -
:_,,ORAPING:PE iAlT: REOUIRED YES Q NO ❑-
_ K ORDINANCE OF FEEY REQUIRED ON RE
c s:- g!;Ji ±`•.QATE%lr-�J__ .� SIGNATURE OF LAND USE OFFICIAL
DEDICATION"REQUIRED; YES, ❑ NO 0 NO. OF FEET t
;•r?' w`.: CURB -AND GUTTER REQUIRED: -YES [I NO (]REET
E ABOVE CONSTRUCT! r r
:'i•t�'-::' THE ON? 'YES 0 NO 0 c
`CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES 0 NO 0
;,; �;;;;,". :;�,• ACCEPTABLEAP�TION BEEN MAGE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
IMPROVEMENT? YES NO p ---• � , .1y � ,� -
- O°' :'DAT ' __ • SIGNATURE OF ROAD DEPT.FFiC(AL`''
P
SWIMMING.POOL5 P U 8 L I C
771
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,.,.;'SEWAGE
F.00D'ESTABLISHMENY ,.
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FLOOD•;ONTROL
; At• :p0 LUTION
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